Lumbar Technique

Numerous technical descriptions exist for lumbar z-joint injections performed under CT or fluoroscopy guidance (10,22-26). Some prefer the CT technique because the posterior joint space can be readily identified (Fig. 9). The anatomy of the lumbar z-joints is such that there is a C-shaped auricular curve from anterior to posterior, which is variable. There are two main fluoroscopic techniques used for accessing the lumbar z-joints—oblique and posterior. In both approaches the patient is prone on a radiolucent table with pillows or cushions underneath the abdomen to decrease the lumbar lordosis and increase the size of the inferior recess.

In the oblique approach (22,25), the C-arm is started in the PA projection and centered over the joint of interest. While using continuous fluoroscopy, the tube is rotated toward the lateral direction until the first profile of the articular margins (as defined by sclerotic lines) is encountered (Fig. 10). This should be the posterior joint space. Note that the traditional 45° oblique position ("Scotty dog") profiles the anterior aspect of the joint (anterior joint space) but t

FIGURE 9 Lumbar zygapophyseal (facet) joint injection lumbar [computed tomography (CT) guidance]. CT image shows a needle positioned in a lumbar zygaphophyseal joint.

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